Health Indicator Report of COPD Hospitalizations and ED Visits

Why Is This Important?

Chronic Obstructive Pulmonary Disease (COPD) is a large group of lung diseases characterized by airflow obstruction and is often associated with symptoms related to difficulty in breathing, but can be present without any symptoms. The most important and frequent conditions in COPD are chronic bronchitis and emphysema, but also includes other diagnoses.
Chronic lower respiratory disease, primarily COPD, was the third leading cause of death in the United States in 2014 (1). Almost 15.7 million Americans (6.4%) reported that they have been diagnosed with COPD (2). However, it is commonly accepted that COPD is frequently underdiagnosed (3), so the actual number may be higher.
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# National Center for Health Statistics. Health, United States 2015 with Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD: US Dept. Health and Human Services; 2016. ([http://www.cdc.gov/nchs/hus/]) Accessed September 12, 2017.
# Wheaton AG, Cunningham, TJ, Ford ES, Croft JB. Employment and activity limitations among adults with chronic obstructive pulmonary disease--United States, 2013. MMWR. 2015:64 (11):290-295.
# Chi MJ, Lee CY, Wu SC. The prevalence of chronic conditions and medical expenditures of the elderly by chronic condition indicator (CCI). Arch Gerontol Geriatr. 2011 May-Jun;52(3):284-9. Epub 2010 May 10.

Graph

Data Table

Data Notes

Data Source

Data Interpretation Issues

As of October 1, 2015, the U.S. is currently using the 10th revision of the International Classification of Diseases (ICD-10) to code hospitalizations and emergency department visits. Prior to the change, COPD hospitalizations and emergency department vists were defined as any ICD-9 primary diganosis code that included 490, 491, 492, and 496. Code 493.2 was used if any of the previous code were present in secondary diagnosis codes. These are now defined using ICD-10 codes J40, J41, J42, J43, and J44. Comparison of data prior to the code change may not be appropriate.
A measure using all COPD hospitalizations will include some transfers between hospitals for the same person for the same event. Variations in the percentage of transfers or readmissions for the same event may vary by geographic area and could impact rates.
Data on race and ethnicity are not routinely collected in all states. This data is not consistently recorded on medical records and when available is complicated further by non-standard definitions of race and ethnicity, the use of combined race/ethnicity, reporting of multiple race categories, and differences in self-report versus registrar reporting.
Without reciprocal reporting agreements with abutting states, statewide measures and measures for geographic areas (e.g., counties) bordering other states may be underestimated because of health care utilization patterns. Each state must individually obtain permission to access and, in some states, provide payment to obtain the data.
Veterans Affairs, Indian Health Services, and institutionalized (prison) populations are excluded.
Practice patterns and payment mechanisms may affect diagnostic coding and decisions by health care providers to hospitalize patients.
Sometimes the mailing address of a patient is listed as the residence address of the patient.
Patients may be exposed to environmental triggers in multiple locations, but geographic information is limited to residence.

Health Indicator Definition

Definition

__Hospitalizations__ [[br]]
1. Number of hospitalizations for COPD [[br]]
2. Crude rate of hospitalizations for COPD per 10,000 population [[br]]
3. Age-adjusted rate of hospitalization for COPD per 10,000 population aged 25 years or older
__Emergency Department (ED) Visits__ [[br]]
4. Number of ED visits for COPD [[br]]
5. Crude rate of ED visits for COPD per 10,000 population [[br]]
6. Age-adjusted rate of ED visits for COPD per 10,000 population aged 25 years or older

Numerator

__Hospitalizations__ [[br]]
Hospitalizations during a calendar year with COPD (ICD-9-CM 490-492 or 496 as the primary diagnosis or 493.2 as a primary diagnosis when 490-492 or 496 is present in any of the secondary diagnosis fields; ICD-10-CM codes J40-J44); all hospitalization, transfers to other hospitals included (not considered duplicates); duplicate inpatient records removed
__Emergency Department (ED) Visits__ [[br]]
Emergency department (ED) visits during a calendar year with COPD (ICD-9-CM 490-492 or 496 as the primary diagnosis or 493.2 as a primary diagnosis when 490-492 or 496 is present in any of the secondary diagnosis fields; ICD-10-CM codes J40-J44) (all ED visits, including those resulting in hospitalization); transfers to other hospitals included (not considered duplicates); duplicate records for ED visits removed

Denominator

Midyear resident population estimates for the state from U.S. Census Bureau (for rate measures)
Adjustment: Age-adjustment by the direct method to year 2000 U.S. standard population

Utah DOH

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